The Good, the Bad, and the Ugly About Design in Health Care

Design-thinking can often involve brainstorming in teams using post-its (Michael Coghlan / Flickr)

Imagine a hospital or clinic that took design as seriously as a company like Apple, with its fanatical attention to detail and easy-to-use products.

Instead, design is too often an afterthought in most health care circles. Many of us have grappled with 1990s-era websites, incomprehensible medical jargon, and windowless hospital waiting rooms that are reminiscent of a prison.

For years, San Francisco-based designer Aaron Sklar has been preaching the importance of design-thinking to entrepreneurs, large health systems and other industry stakeholders. But until recently, he says, this topic rarely came up at top health conferences.

"There's a lot of pointing the finger at the patient. What design can bring to health care isn't just the technology, but the patient-centered approach." Aaron Sklar, Director of Experience Strategy and Design at Healthagen

But something's changed. Earlier this month, I caught up with Sklar for coffee to find out more about how design is slowly creeping into health care. Sklar works as a designer at Aetna-owned Healthagen, a company that focuses on engaging patients through mobile and web-based tools.

This interview has been condensed and edited for brevity.

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In your experience, how is design perceived by top health decision-makers, like hospital executives and doctors?

Design has not traditionally been viewed as an essential part of health care. To change that, we need to show health systems that good design is worth the investment.

In my own work, I try to draw attention to other aspects of design than just physical hospital design and graphic design, which are the most well-known. A lot of what interests me is under the umbrella of 'service design,' meaning the interaction between patients and care providers, and how to make that more effective and delightful. In all these cases, hospitals can save money when patients receive a better experience and are able to heal faster.

I am starting to see a growing awareness of design. Six months ago, nobody was really talking about this. But last month, I went to three different symposiums and all had the title of 'design and health care.' It has become a hot topic.

Aaron Sklar worked for 15 years at storied design firm IDEO, and started a website on health care design, called Prescribe Design. (Christina Farr / KQED)

How about all this new health technology, which includes mobile apps and digital medical records? Is this an example of great design?

In the past five years, there has been a flood of technology that is coming into health care. With a limited number of exceptions, it often misses the mark of what it promises. As a designer, it's embarrassing.

Why did you start your website, Prescribe Design, and who are you trying to target?

We launched the site about six months ago. We see a big potential audience as health care practitioners, who want to make a change. They increasingly see design as an important tool, so we provide case-studies that they can download and use. I started it because I saw first-hand how important technology and design-thinking could be for health care. Magical things can happen.

How do most health systems view design today?

It's all about functionality and the minimum viable product, or 'MVP'. The approach has been to put in the least amount of effort and resources to get the product working, and then fix it later. But what's been missing is the follow-through -- and this is certainly true for hospital building-design, which is insanely expensive. When designers get involved in the process, doctors and patients can expect better.

What are some inexpensive tweaks that hospitals can make to the physical space to improve the experience for patients?

Anything from larger windows to make hospital rooms more light-filled, or taking steps to reduce construction noise. Tweaks that require larger investment, but are shown to be beneficial, are things like healing gardens for strolling, an art space or meditation room or a social space on the patient floor. This can all lead to increased philanthropy and loyalty to the hospital, as well as positive brand awareness.

Products like the iPhone are built to delight the user. Meanwhile, most people dread health care interactions and visits. How long will it take before there's any delight involved with the health care experience?

This may seem overly optimistic, but I am going to say that in five years it will be common to experience some sort of delight. This will be a critical goal for hospitals. I don't think that hospitals will utterly redesign their buildings, which is very expensive, but they can provide new tools and services that are easy to use. It might be something simple like an online scheduling system, so you don't have to take time out from your workday to call your doctor and sit on hold.

What's the biggest shift you're seeing in how health systems are approaching design?

I've seen several major hospitals developing their own innovation and design teams -- in the past, this was typically the R&D group. Some examples include Penn Medicine and Johns Hopkins, which have innovation centers, and Kaiser, which has its own design consultancy.

Another is this role that is popping up in the new world of 'accountable care.' Now that hospitals are increasingly accountable for patients staying healthy, the case manager has become really important. I love hearing stories about great case managers who make the effort to talk to patients over the phone and find out what's really going on.

What are the biggest mistakes you see hospitals and clinics make from a design perspective?

The worst pitfall is bringing design in at the end to make it all look pretty. Design isn't the icing on the cake or an afterthought; it's about user experience. You have to start at the beginning of the process if you want your design to have a tangible impact.

Have you seen many examples of where patients are perceived as disinterested in their health, because they don't engage with tools that are poorly-designed and difficult to use?

Yes, many. The entire health care system has been based on this notion that the doctor is the hero. The doctor deduces the problem and sits back and shakes their heads when the patient isn't doing what they were told, whether it's taking their meds or following the right protocols. There's a lot of pointing the finger at the patient. What design can bring to health care isn't just the technology, but the patient-centered approach. How can we meet patients where they are and come up with treatments that will make an impact? How can we use design to help patients follow-through?

As a designer, what got you interested in health care?

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I always wanted to work on projects that had social impact. At IDEO, I did all kinds of health-related projects, including work with the Centers for Disease Prevention and Control (CDC) and a bike company, which wanted to improve people's fitness. Wanting to do good has become a mainstream point of view for young designers. In my opinion, a mindset of empathy is inherent in design culture.